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Vol. 72. Issue 9.
Pages 724-731 (September 2019)
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Vol. 72. Issue 9.
Pages 724-731 (September 2019)
Original article
DOI: 10.1016/j.rec.2018.06.010
Risk Prediction Model of In-hospital Mortality in Patients With Myocardial Infarction Treated With Venoarterial Extracorporeal Membrane Oxygenation
Modelo de predicción de riesgo de mortalidad hospitalaria para pacientes con infarto de miocardio tratados con oxigenador extracorpóreo de membrana venoarterial
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Ki Hong Choia, Jeong Hoon Yanga,b,
Corresponding author
jhysmc@gmail.com

Corresponding author: Division of Cardiology, Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
, Taek Kyu Parka, Joo Myung Leea, Young Bin Songa, Joo-Yong Hahna, Seung-Hyuk Choia, Jin-Ho Choia,c, Yang Hyun Chod, Kiick Sungd, Keumhee Carrieree,f, Joonghyun Ahnf, Hyeon-Cheol Gwona
a Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
b Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
c Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
d Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
e Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
f Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tables (4)
Table 1. Baseline Characteristics
Table 2. Baseline Angiographic Findings and In-hospital Management
Table 3. Univariate and Multivariate Analyses of Factors Associated With In-hospital Mortality
Table 4. Predicting Scoring System of In-hospital Mortality
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Abstract
Introduction and objectives

There are limited data to develop a risk prediction model of in-hospital mortality for acute myocardial infarction (AMI) patients treated with venoarterial (VA)-extracorporeal membrane oxygenation (ECMO). We aimed to develop a risk prediction model for in-hospital mortality in patients with AMI who were treated with VA-ECMO.

Methods

A total of 145 patients with AMI who underwent VA-ECMO between May 2004 and April 2016 were included from the Samsung Medical Center ECMO registry. The primary outcome was in-hospital mortality. To develop a new predictive scoring system, named the AMI-ECMO score, backward stepwise elimination and β coefficient-based scoring were used based on logistic regression analyses. The leave-one-out cross-validation method was performed for internal validation.

Results

In-hospital mortality occurred in 69 patients (47.6%). On multivariable logistic regression analysis, the AMI-ECMO score comprised 6 pre-ECMO or angiographic parameters: age> 65 years, body mass index> 25 kg/m2, Glasgow coma score <6, lactic acid> 8 mmol/L, anterior wall infarction, and no or failed revascularization. The C-statistic value of AMI-ECMO score for predicting in-hospital mortality was 0.880 (95%CI, 0.820-0.940). The incidence of in-hospital mortality after VA-ECMO insertion was 6.2%, 28.1%, 51.6%, and 93.8% for AMI-ECMO score quartiles (0 to 16, 17 to 19, 20 to 26, and> 26), respectively (P <.001 for trend). The AMI-ECMO scores were also significantly associated with the estimated rate of all-cause mortality during follow-up (per 1 increase, HR, 1.11; 95%CI, 1.08-1.14; P <.001).

Conclusions

The AMI-ECMO score can help predict early prognosis in AMI patients who undergo VA-ECMO.

Keywords:
Acute myocardial infarction
Extracorporeal circulation
Risk assessment
Abbreviations:
AMI
CS
ROC
VA-ECMO
Resumen
Introducción y objetivos

Hay poca información para el desarrollo de modelos de predicción del riesgo de mortalidad hospitalaria para pacientes con infarto agudo de miocardio (IAM) tratados con oxigenador extracorpóreo de membrana (ECMO) venoarterial (VA). El objetivo es desarrollar un modelo de predicción del riesgo de mortalidad hospitalaria para pacientes con IAM tratados con ECMO-VA.

Métodos

Entre mayo de 2004 y abril de 2016, se trató con ECMO-VA a un total de 145 pacientes con IAM incluidos en el registro de ECMO del Samsung Medical Center. El objetivo primario fue la mortalidad hospitalaria. Para el desarrollo del nuevo modelo predictivo, llamado puntuación AMI-ECMO, se usó el método de eliminación por pasos hacia atrás y la puntuación basada en el coeficiente β en el análisis de regresión logística. El método de validación cruzada dejando uno fuera se usó para la validación interna.

Resultados

Se produjo la muerte hospitalaria de 69 pacientes (47,6%). Para el análisis de regresión logística multiple, la puntuación AMI-ECMO incluyó 6 parámetros previos al ECMO o angiográficos: edad> 65 años, índice de masa corporal> 25, escala de coma de Glasgow <6, ácido láctico> 8 mmol/l, infarto de miocardio anterior y la ausencia o fallo de revascularización. El valor del estadístico C de la puntuación AMI-ECMO para la predicción de la mortalidad hospitalaria fue 0,880 (IC95%, 0,820-0,940). La mortalidad hospitalaria tras la inserción del ECMO-VA fue del 6,2, el 28,1, el 51,6 y el 93,8% (p <0,001 para análisis de tendencias) en cada cuartil de AMI-ECMO (0 a 16, 17 a 19, 20 a 26 y> 26). La puntuación AMI-ECMO se asoció también significativamente con la tasa estimada de mortalidad por todas las causas durante el seguimiento (por cada incremento de 1 punto, HR=1,11; IC95%, 1,08-1,14; p <0,001).

Conclusiones

La puntuación AMI-ECMO puede ayudar en la predicción del pronóstico temprano de pacientes con IAM tratados con ECMO-VA.

Palabras clave:
Infarto agudo de miocardio
Circulación extracorpórea
Determinación del riesgo

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